High incidence of venous thrombosis after surgery for abdominal aortic aneurysm
Received 11 July 2008; accepted 4 October 2008.
Objective
The incidence of venous thromboembolism (VT) after aortic abdominal aneurysm (AAA) surgery is imprecisely reported. On one hand, thromboprophylaxis has improved, on the other hand, AAA patients have become older and/or present worse comorbidities. Herein, we prospectively analyzed the incidence of VT in a continuous series of patients operated on for AAA repair and looked for predictive factors.
Materials and Methods
Between January 1, 2005, and December, 31, 2006, 193 consecutive patients (177 men and 16 women), mean age 73 (range, 47-93) underwent elective AAA repair, 137 open (71%) and 56 endovascular (29%), in our institution. Thromboprophylaxis consisted of thigh-length compression bandages or stockings, early mobilization, and a daily subcutaneous injection of low-molecular-weight heparin (enoxaparin 40 mg per day). Patients with renal insufficiency or aged over 80 were given unfractionated heparin (5000 IU twice a day). Heparin was started between day 1 and day 5 (median = day 1) after surgery, according to the prescription of the surgeon. A bilateral lower limb duplex venous compression ultrasonography scan using 3 to 7.5 MHz transducers was systematically done before and after surgery in each patient. Two groups were considered: group 1 with postoperative VT (n = 17) and group 2 without (n = 176). The 17 patients with VT were compared with 51 patients randomly chosen among the 176 patients without VT. Different characteristics such as venous risk factors, preoperative antithrombotic treatment, anatomical features of the AAA, and perioperative data were studied.
Results
Seventeen patients (8.1%) were diagnosed with postoperative VT (15 asymptomatic deep vein thrombosis [DVT] and 2 symptomatic pulmonary embolisms [PE]). VTE tended to be more frequent in open (10.2%) than endovascular (5.3%) repair (P = .28). Among perioperative data, delay to thromboprophylaxis was related to bleeding complication (P = .05) and blood transfusion (P = .02), and tended to be longer in VT patients (1.7 +/− 1.4 vs 0.9 +/− 0.9 day; P = .09).
Conclusion
Despite systematic prevention with heparin, surgery for AAA repair induces a high incidence of postoperative VT. This series mandates for vigilance about VT, with particular attention to the patients who received transfusion with fresh frozen plasma. Even though this series is one of the largest ever published on this topic, the rarity of the events calls for confirmation with a larger prospective study.
aDepartment of Biology and Haematology, CHU Dijon, Dijon, France
bDepartment of Angiology, CHU Dijon, Dijon, France
cDepartment of CardioVascular Surgery, CHU Dijon, Dijon, France
dDepartment of Clinical Research, CHU Dijon, Dijon, France
eINSERM U866, University of Burgundy Medical School, Dijon, France
Reprint requests: Dr Eric F. Steinmetz, MD, Department of Cardiovascular Surgery, CHU Le Bocage, BP 77908, 21079 Dijon Cedex, France
This study was supported by a grant from the University Hospital of Dijon and the Regional Council of Burgundy. Reference: AOI 2003.
ABSTRACT